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LAPORAN PAGI

GLADIAN YANURISKA
10/296369/KU/13606
Kelp 14204

IDENTITAS PASIEN
Nama

: By TL

Jenis Kelamin

: Perempuan

Tanggal lahir

: 24 Februari 2015

Alamat

: Jetis Baran Sardonoharjo, Nganglik, Sleman, Yogyakarta

Tgl periksa

: 5 Maret 2015

No. RM

: 007417xx

Diagnosa klinis

: HMD grade II, BPD grade 1

Click icon to add picture

FOTO
BABYGRAM

URAIAN HASIL
PEMERIKSAAN
Foto Babygram, asimetris, kondisi cukup, hasil :
THORAX :
Pengembangan kedua paru cukup
Tampak perselubungan semiopaq

inhomogen batas tidak tegas di


kedua pulmo, air bronchogram (+)
Kedua pleural space tak menebal
Kedua diafragma licin dan tak
mendatar
Konfigurasi cor normal
Tampak ujung distal ETT di proyeksi
airway setinggi VTh IV

ABDOMEN :
Pre peritoneal fat line jelas
Tak tampak distensi abdomen
Distribusi udara usus (+)
Sistema tulang intact

KESAN
THORAX

ABDOMEN

Bronchopulmonary Dysplasia

stage I
Ujung distal ETT di proyeksi

airway setinggi VTh IV


Konfigurasi cor normal

Tak tampak kelainan

PEMBAHASAN
BRONCHOPULMONARY DYSPLASIA

BRONCHOPULMONARY
DYSPLASIA (BPD)
BPD merupakan penyakit paru kronis yang melibatkan abnormalitas pembentukan

jaringan jaringan paru, dapat disertai adanya inflamasi dan jaringan parut pada paru.
Faktor resiko yang paling sering menyebabkan BPD adalah bayi prematur (<34

minggu) yang membutuhkan terapi oksigen dan ventilasi tekanan positif, extremely
low birth weight (<1,000 gram) dan infeksi postpartum.
"Broncho" : to the airways (the bronchial tubes).
"Pulmonary" refers to the lungs' tiny air sacs (alveoli).
"Dysplasia" : perubahan struktur sel pada saluran napas kecil dan alveoli yang

mengakibatkan kesulitan dalam bernapas dan mengganggu fungsi dari paru.


Dibandingkan dengan asthma and cystic fibrosis, BPD adalah penyakit kronis paling

sering pada anak. Menurut National Heart, Lung, and Blood Institute (NHLBI), antara
5,000 dan 10,000 kasus BPD terjadi setiap tahun di United States.

PATHOLO
GY

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SIGNS AND
SYMPTOMS
Tachypnea
Tachycardia
Increased respiratory

effort (with retractions,


nasal flaring, and
grunting)
Frequent desaturations
Significant weight loss

during the first 10 days of


life.

STAGES OF PATHOLOGIC
APPEARANCE
In

stage 1 (1-3 days), the pathologic


appearances of BPD are identical to those
of respiratory distress syndrome
where there is not enough surfactant in
the lungs. Surfactant helps to lower
surface tension in the airways and this
helps keep the lung alveoli open. It
involves
the
presence
of
hyaline
membranes,
atelectasis,
vascular
hyperemia, and lymphatic dilatation, (EMedicine, 2009).

In stage 2 (4-10 days), lung destruction

resulting in ischemic necrosis of airways


occurs due to stretching of the terminal
bronchioles.
Immediate
reparative
changes in the lungs as well as
bronchiolar obstruction are also seen in
this stage. Hyaline membranes can persist

Stage 3 (11-20 days) involves progressive repair

of the lung, with a decreased number of


alveoli. There is compensatory hypertrophy of the
remaining alveoli, and hypertrophy of bronchial-wall
muscle and glands. Regenerating clear cells are
seen, along with exudation of alveolar macrophages
and histiocytes into airways. Airtrapping, pulmonary
hyperinflation,
tracheomegaly,
tracheomalacia,
interstitial edema, and ciliary dysfunction may also
be present, (E-Medicine, 2009).
In stage 4 (>1 month), emphysematous alveoli

are seen. Chronic lung damage eventually causes


Pulmonary hypertension (caused by thickening of the
inner-most lining of pulmonary arterioles), and
results in cor pulmonale. Fibrosis, atelectasis, a
cobblestone appearance due to uneven lung
aeration, and pleural pseudofissures are often seen.
Marked hypertrophy of peribronchiolar smooth
muscle is present, (E-Medicine, 2009).

STAGES OF RADIOGRAPHIC
Stage 3 (10-20 d) is characterized
CHANGES
IN
BPD
by a classic bubbly appearance
In stage 1 (< 3 d), characteristic

features of RDS are seen, as can


complications
of
RDS
(eg,
pneumothorax and pulmonary
interstitial emphysema [PIE]).
In stage 2 (4-10 d), persistent

radiographic findings should alert


the clinician to the development
of BPD. Fine or course interstitial
opacities are frequently seen.
This
stage
has
a
diffuse
distribution and no specific lobar
predilection. In severe cases,
changes are widespread and
coarse.

and irregular dense areas, opaque


areas.

In stage 4 (>1 mo), images show

hyperexpansion of the lung,


expanding bubbles, and strands.
When present, air trapping is
more common in the lower lobes
than
in
the
upper
lobes.
Pulmonary hyperinflation is seen
in the most severe cases. Clearly
defined Northway stages are
hardly seen in current practice, in
which RDS is not a prerequisite
for BPD.

GAMBARAN
BABYGRAM
NORMAL
Visualization
of
dorsal
intervertebral spaces through the
cardiac silhouette (film density);

Right hemi-diaphragm at the

level of the posterior arc of the


eighth rib (satisfactory level of
pulmonary aeration);
Caudal inclination of anterior

costal arcs appearing underneath


the posterior ones (adequate
centralization of the central
beam on the thoracic cage);
Symmetry of bone structures on

both sides of the thoracic cage


(correct
positioning
of
the
neonate);

Click icon to add picture

STAGE 1 (1-3
DAYS AFTER
BIRTH)

Resulted in the typically


granular opacities of NRDS.
Supine chest radiograph
obtained at 1 day of age
reveals a ground glass
appearance to the lungs.

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Supine chest
radiograph
obtained at 1
week of age
reveals a ground
glass
appearance to
the lungs.

Click icon to add picture


STAGE 2 (4-10 DAYS)
Demonstrated granular
opacities and with
superimposed complete
pulmonary opacification in
more severe cases
Bronchopulmonary
Dysplasia.The lungs are
usually overaerated, in this
case the left
more than the right. There
are diffuse rope-like densities
separated in some areas by
zones of hyperlucency. The
densities are coalescent in
many areas. The heart
borders are completely
obliterated.

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Supine chest
radiograph obtained at
10 days of age reveals
complete
opacification of the
lungs.

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STAGE 3 (10-20
DAYS)
Revealed small cystic
lucencies alternating
with small focal
opacities
Supine and lateral chest
radiographs obtained at
20 days of age show the
development of small
cystic lucencies in the
lungs and increased
lung volume

Supine chest
radiograph
obtained at 1
month of age shows
the development of
small cystic
lucencies in the
lungs.

Click icon to add picture


STAGE 4
(>1MONTHS)

Showing a bubbly
appearance due to
enlargement of cystic
lucencies and linear or
ropy opacities.

Supine chest radiograph


obtained at 2 months of
age shows continued
development of small
cystic lucencies in the
lungs.

Click icon to add picture

Supine chest radiograph


obtained in the same patient at 5
months of age shows the small
cystic lucencies to have
coaelesced into larger lucencies
with interspersed fibrotic
stranding.

Click icon to add picture

Supine chest radiograph


obtained at 7 months of
age shows the small
cystic lucencies to have
coaelesced into larger
lucencies with
interspersed fibrotic
stranding. Increased
lung volumes are also
present.

MANAJEMEN

Pharmacotherapy
Diuretics (eg,

furosemide)
Surfactant replacement with

oxygen supplementation
Continuous positive airway

pressure (CPAP)
Mechanical ventilation

Bronchodilators (eg,

albuterol, caffeine
citrate, theophylline,
ipratropium bromide)
Corticosteroids (eg,

dexamethasone)
Vitamins (eg, vitamin A)

Infants with

bronchopulmonary
Diet

dysplasia have increased


energy requirements. The
following nutritional
strategies may help infants
and their lungs grow and
develop:

Administration of early

parenteral nutrition
Maximization of protein,

carbohydrates, fat,
vitamins, and trace metals
intake

Supplementation with

antioxidant enzymes and


vitamins A and E
Administration of free

water (avoid fluid


overload)
Protein and fat

supplementation
Early enteral feeding of

small amounts (even


with umbilical lines in
place), followed by slow,
steady increases in
volume: To optimize
tolerance of feeds and
nutritional support

REFERENSI
radiologiabrasileira@cbr.org.br
http://www.virtualpediatrichospital.org/

TERIMA KASIH